Application of DynaCT angiographic reconstruction in balloon pulmonary angioplasty

Lin, Jielong; Chen, Haiming; Lin, Feng-Cheng; Li, Jieying; Xie, Chengxin; Guo, Wenliang; Huang, Xiu-Fen; Hong, Cheng

doi:10.1007/s00330-020-07028-9

Cited by 11 publications

(16 citation statements)

References 17 publications

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“…This is important for BPA, an interventional procedure that targets webs, bands, and stenosis in distal areas of the pulmonary vasculature [10,20]. Several studies on CTEPH patients reported that a detailed depiction of the pulmonary vascular tree helps to evaluate suitable treatment options and to optimize peri-interventional guidance since successful BPA depends on the clear depiction of target lesions in sub-segmental pulmonary arteries [1,3,9]. However, up to 7 % of CACT scans acquired during diagnostic workup of patients with CTEPH show impaired image quality mainly due to severe motion artifacts, emphasizing the importance of a comprehensive motion correction algorithm to obtain high-quality diagnostic CACT images and to gain sufficient and valuable information as well as to avoid repeated image acquisitions [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, bones interfere with the depiction of structures of interest and need to be removed manually by volume punching of the dataset. This requires two to five minutes [1,3,9]. However, bone removal is also necessary to prepare the CACT dataset as an overlay for BPA guidance [3].…”

Section: Discussionmentioning

confidence: 99%

“…Early reports summarized that CACT has the potential to expedite interventional procedures that require three-dimensional information and navigation [7,8]. This is especially true for complex procedures such as balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) where CACT guidance gains increasing importance [3,9]. BPA is a treatment option for inoperable CTEPH patients and addresses peripheral web-like stenoses and intraluminal bands as well as total occlusions in segmental and sub-segmental pulmonary arteries as low as 1 mm in diameter.…”

Section: Introductionmentioning

confidence: 99%

“…Here, CACT serves as a diagnostic tool to provide accurate diagnosis and precise evaluation of suitable lesions for BPA. Moreover, CACT enables the identification of lesions in a complex 3-dimensional vasculature, facilitating the potentially challenging passing of target lesions safely, thus minimizing the risk for potentially life-threatening complications [1,9]. Hence, BPA benefits from optimal procedure guidance and the clear identification of small intravascular targets [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, CACT enables the identification of lesions in a complex 3-dimensional vasculature, facilitating the potentially challenging passing of target lesions safely, thus minimizing the risk for potentially life-threatening complications [1,9]. Hence, BPA benefits from optimal procedure guidance and the clear identification of small intravascular targets [9][10][11]. However, the image quality of CACT can be somewhat limited by motion artifacts, especially in patients with shortness of breath [4,12].…”

Section: Introductionmentioning

confidence: 99%

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Motion Reduction for C-Arm Computed Tomography of the Pulmonary Arteries: Image Quality of a Motion Correction Algorithm in Patients with Chronic Thromboembolic Hypertension During Balloon Pulmonary Angioplasty

Maschke¹,

Werncke²,

Becker³

et al. 2021

Rofo

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Purpose To evaluate the feasibility and image quality of a motion correction algorithm for supra-selective C-arm computed tomography (CACT) of the pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA). Materials & Methods CACT raw data acquired during 30 consecutive BPAs were used for image reconstruction using either standard (CACTorg) or a motion correction algorithm (CACTmc), using 400 iterations. Two readers independently evaluated 188 segmental and 564 sub-segmental contrast-enhanced pulmonary arteries in each reconstruction. The following categories were assessed: Sharpness of the vessel, motion artifacts, delineation of bronchial structures, vessel geometry, and visibility of treatable lesions. The mentioned criteria were rated from grade 1 to grade 3: grade 1: excellent quality; grade 2: good quality; grade 3: poor/seriously impaired quality. Inter-observer agreement was calculated using Cohen’s Kappa. Due to an excellent agreement, the ratings of both readers were merged. Differences in the assessed image quality criteria were evaluated using pairwise Wilcoxon signed-rank test. Results Inter-observer agreement was excellent for all evaluated image quality criteria (κ > 0.81). For all assessed image quality criteria, the ratings on CACTorg were good but improved significantly for CACTmc to excellent for the whole vascular tree (p < 0.01). When considering segmental and sub-segmental levels individually, all image quality criteria improved significantly for CACTmc on both levels (p < 0.01). While ratings of CACTmc were constant for both levels (segmental and sub-segmental) for all criteria, the ratings of CACTorg were slightly impaired for the sub-segmental arteries. Conclusion Motion correction for supra-selective contrast-enhanced CACT of the pulmonary arteries is feasible and improves the overall image quality. Key Points: Citation Format

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Motion Reduction for C-Arm Computed Tomography of the Pulmonary Arteries: Image Quality of a Motion Correction Algorithm in Patients with Chronic Thromboembolic Hypertension During Balloon Pulmonary Angioplasty

Maschke¹,

Werncke²,

Becker³

et al. 2021

Rofo

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CXCL10 levels in diagnosis and improved hemodynamics in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty

Hong

Chen

et al. 2022

Pulm. circ.

Self Cite

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease characterized by pulmonary artery stenosis or obstructions resulting from insufficient thrombus resolution. Chemokine (C‐X‐C motif) ligand 10 (CXCL10) is a chemokine that contributes to the pathogenesis of many autoimmune diseases and cancers. The present study aims to investigate the levels of CXCL10 in patients with CTEPH throughout balloon pulmonary angioplasty (BPA) and its correlation with the improvement of pulmonary hemodynamics. Plasma CXCL10 levels were measured in 38 CTEPH patients with 100 BPA sessions and in 28 healthy controls. Correlations between CXCL10 and pulmonary hemodynamics were investigated. Receiver operating characteristic (ROC) curves were plotted to display the diagnostic value and the predictive ability for perioperative complications of CXCL10 and CXCL10‐related models. Nomograms were plotted to visualize the diagnostic value and the predictive ability for perioperative complications of CXCL10 and CXCL10‐related models. CXCL10 levels are higher in CTEPH patients compared with healthy controls (36.5 [95% confidence interval {CI}: 25.0–51.1] vs. 14.8 [95% CI: 11.1–30.9], p < 0.0001) and decreased significantly after BPA treatment (36.5 [95% CI: 25.0–51.1] vs. 24.7 [95% CI: 17.2–36.6], p < 0.0005). Preoperative CXCL10 levels positively correlated with mean right atrial pressure ( r = 0.25), systolic pulmonary artery pressure (PAP; r = 0.28), diastolic PAP ( r = 0.33), mean PAP ( r = 0.36), pulmonary vascular resistance ( r = 0.31), and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP; r = 0.46). Furthermore, plasma CXCL10 levels adjusting for age and sex displayed a sensitivity of 86.0% and a specificity of 67.9% for discriminating CTEPH patients from healthy controls. Preoperative CXCL10 levels, in combination with NT‐proBNP, predicted perioperative complications with a sensitivity of 100.0% and a specificity of 46.9% as displayed in ROC analysis. In conclusion, circulating CXCL10 might contribute to the evaluation of disease severity in CTEPH patients and be useful to evaluate the treatment effect of BPA. Future studies are warranted to further study the relationship between pulmonary hemodynamics and circulating CXCL10.

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Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: What Does the Future Hold?

Zilinyi

Sethi²,

Kirtane³

2022

Balloon Pulmonary Angioplasty in Patients With CTEPH

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Application of DynaCT angiographic reconstruction in balloon pulmonary angioplasty

Cited by 11 publications

References 17 publications

Motion Reduction for C-Arm Computed Tomography of the Pulmonary Arteries: Image Quality of a Motion Correction Algorithm in Patients with Chronic Thromboembolic Hypertension During Balloon Pulmonary Angioplasty

Motion Reduction for C-Arm Computed Tomography of the Pulmonary Arteries: Image Quality of a Motion Correction Algorithm in Patients with Chronic Thromboembolic Hypertension During Balloon Pulmonary Angioplasty

CXCL10 levels in diagnosis and improved hemodynamics in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty

Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension: What Does the Future Hold?

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